髓外和髓内固定及髋关节置换治疗高龄股骨粗隆间骨折隐性失血的特点分析

Features analysis of hidden blood loss in the elderly femoral intertrochanteric fractures treated with extramedullary and intramedullary fixations or hip arthroplasty

目的:分析髓外固定动力髋螺钉(DHS)和髓内固定(Gamma 3,PFN)以及人工髋关节置换(LBFH)治疗高龄股骨粗隆间骨折患者围手术期隐性失血的特点。方法 :回顾性分析我院193例采用DHS、Gamma 3、PFNA及LBFH治疗高龄患者(年龄≥75岁)股骨粗隆间骨折患者的临床资料,使用Gross方程,根据患者身高、体重、术前和术后的血常规变化,比较各组围手术期的隐性失血量情况。结果:髓内固定总出血量最高,其中PFN组[(887±75)m L]和Gamma 3组[(903±91)m L]之间差异无统计学意义(P>0.05),高于DHS组[(766±83)m L,P<0.05]。髓内钉组的隐性出血量最多,其中PFN组([711±153)m L,占80%]及Gamma 3组[(742±137)m L,占82%]之间比较差异无统计学性(P>0.05),高于LBFH组[(453±98)m L,占54%]及DHS组[(429±59)m L,占56%](P<0.05)。结论:高龄股骨粗隆间骨折隐性失血在围手术期失血中占有较大比例,若采用髓内固定术后则隐性出血量更多,是术后贫血的主要原因,需引起重视。

Objective To analyze the features of hidden blood loss in the elderly femoral intertrochanteric fractures treated with extramedullary dynamic hip screw（DHS）, intramedullary nails（Gamma 3, PFN） and hip arthroplasty（LBFH）. Methods The clinicle records of 193 elderly patients（ages ≥75 year old） with femoral intertrochanteric fractures treat by DHS,Gamma3, PFNA and LBFH in our hospital were retrospectively analyzed.The estimated blood loss were calculated by Gross equation, according to the height,weight and changes of blood routine test reoperative and postoperative,the differences of hidden blood loss among DHS group,Gamma 3group, PFN group and LBFH group were compared. Results Total blood loss in intramedullary nail groups were significantly higher than DHS group [（766 ± 83） m L],P〈0.05）. No significant difference was found between PFN group [（887 ± 75） m L] and Gamma 3 group [（903 ± 91） m L]（P〉0.05）, The hidden blood loss were significantly higher in the intramedullary nail groups than those in the LBFH group [（453 ± 98） m L,accounting54% ] and DHS group [（429 ± 59） m L,accounting 56% ]（P〈0.05）. No significant difference of hidden blood loss was found between Gamma 3 group [（742 ± 137） m L, accounting 82% ] and PFN group [（711 ± 153）m L,accounting 80% ],（P〉0.05）. Conclusion Noteworthy, the hidden blood loss is major part of perioperative total blood loss in the elderly femoral intertrochanteric fractures, intramedullary fixations may result in greater hidden blood loss than extramedullary fixations and hip arthroplasty,which may cause postoperative anemia.